全腹腔镜下保胆取石、取息肉和即时缝合术的应用

Report on laparoscopic removal of cholecyst lithiasis and polyp with primary closure of cholecyst incision.

目的探讨全腹腔镜下保胆取石、取息肉和即时缝合术的手术方法和适应证。方法132例患者在全麻下采用腹腔镜胆囊切除术的标准四戳孔，借助胆管镜、取石网、电热圈套器和斑马导丝处理胆囊结石和胆囊息肉，胆囊壁切口用2-0或3-0可吸收缝线连续扣锁缝合或问断8字缝合，取出的胆囊结石和胆囊息肉装入标本袋从剑突下孔或脐部孔取出。Winslow孔附近常规放置两根多孔腹腔引流管观察渗漏情况。结果施行保胆取石即时缝合术117例和保胆取息肉即时缝合术15例，成功114例，中转为腹腔镜胆囊切除术13例，胆漏2例，残余结石1例，再生结石1例，胆管出血1例。腹腔引流管引流出渗出液20—300ml／d，术后2～7d拔除。无中转开腹，无死亡。手术历时30—160min，平均约70min。术后住院3～10d。结论只要选择合适的患者，确切的胆管镜检查和治疗，可靠的缝合胆囊壁切口，施行全腹腔镜下保胆取石、取息肉和即时缝合术可行、有效、安全。此方法可以保留有功能的胆囊。

Objective To discuss the methods and indications of treating the eholecyst lithiasis and polyp by laparoseopy and eholedochoscopy for preservation of eholeeyst. Methods A prospective study of 132 patients of treating the eholeeyst lithiasis and polyp by laparoseopy and choledoehoscopy for preservation of choleeyst had been operated between Mar. 2002 and Sep.2007. It was first adopted that extraction of the gall bladder stones and cholecyst polyps with choledoehotomy, that the incision of the gall bladder were performed with absorbable suture 2-0 or 3-0（ polyglycolie acid bralded suture ） by suturing method of primary closure of choleeyst incision. Resdts It had completed successful cholecyst clerrance to reach the preestablished object of preservation of choleeyst to 114 patients in total 132 patients. It changed laparoscopic preservation of choleeyst into laparoscopie cholecysteetomy in 13 patients. It had leaked the bile juice continue 4 days and 5 days to heal up in 2 patients, One patient had residual stones then cured with laparoscopic cholecystectomy, One patient had regenerating stones then cured with laparoscopic eholeeysteetomy. One patient had the bleeding of bile duet to heal up with non-operation. Conclusion This method is safety and feasible that had completed successful choleeyst lithiasis and polyp clearance and the incision of the gall bladder were performed with absorbable suture by the primary closure method, it was for preservation of the functional cholecyst.